Background/Purpose: An increased expansion of Th17 cells in the synovial membrane have shown to play a key role in causing persistent synovitis leading to cartilage and bone destruction in RA. MRI is superior to conventional X-rays in detecting erosions in early disease. In this study we sought to see the association of level of peripheral circulatory Th-17  and Th-1 cells with MRI changes in RA

Methods:

RA patients satisfying ACR Criteria 2010 with active disease (DAS28 >3.2) and within 3 years of onset who had not received prior DMARDs or steroids were recruited. MRI of dominant hand and wrist was done using 0.2 Tesla extremity MRI and was scored using OMERACT RA MRI Scoring system 2002 by two radiologists.  Peripheral blood Th1 (CD3+ CD4+ IFNγ +) and Th17 (CD3+ CD4+ IL17+) were enumerated by flow cytometry. Th-1and Th-17 levels were measured in 25 healthy controls. Statistical analysis was done by non-parametric tests using SPSS statistics 21version software.

Results:

Thirty-two consecutive patients  (26 females and 6 males) with RA after obtaining consent were   included. The median age at presentation was 38.5 years (Range 19 – 65 years) with median disease duration of 11.5 months (Range 1-36 months). The median DAS 28 score was 4.35 (Range 3.22 – 6.24). All the patients were seropositive. MRI evaluation revealed synovitis in 93.8%(30/32), Osteitis in 31.3%(10/32) and erosions in 75% (24/32) of patients. On subgroup analysis erosions were present in 67% (12 /18) of cases of early (≤ 1year) RA and in 86% (12/14) of established (> 1 year) RA. OMERACT RA MRI scoring revealed a significantly (p<0.05) higher erosion score (17.8 ± 19.9) in established RA compared to early RA  (5.4 ± 11.4) whereas synovitis and osteitis were similar in both groups. Synovitis score showed modest correlation with ESR (r= 0.43, p =0.02), CRP(r= 0.38, p =0.03), and DAS28 (r= 0.43, p =0.02), while osteitis and erosion score did not correlate with the same.Percentage of Th17 cells in serum were significantly (p<0.05) elevated in patients  (1.57 ± 0.69) compared to healthy controls (0.84 ± 0.45) while Th1 cells did not differ between the groups. However, the increased frequency of Th17 cells  did not show any correlation with acute phase reactants, DAS28 score and MRI proven synovitis or osteitis. 

Conclusion: Peripheral blood Th17 subset was significantly elevated in patients with RA, though they did not correlate with the synovitis, osteitis or erosions in MRI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-of-peripheral-blood-th-17-and-th-1-with-synovitis-and-osteitis-by-mri-in-recent-onset-rheumatoid-arthritis/